Ready or not, here it comes: the transition to ICD-10 codes is slated to go down (finally) as planned this Thursday, October 1. South Nassau Communities Hospital in Oceanside, NY is among those hospitals and health systems that have been ready to bring it on for years.
“I think everybody is just ready for the day to come,” says Richard Rosenhagen, MBA, RHIA, assistant vice president of EHR, health information management and clinical documentation improvement, at South Nassau Communities Hospital.
Given the multiple delays in implementation, South Nassau has used the extra time to go the extra mile in preparation and identifying the risk factors for what they will be encountering, Rosenhagen says.
The 10th revision of the International Classification of Diseases will replace the ICD-9-CM system, now more than 30 years old. It allows providers to code diagnoses and procedures, and is used for tracking health trends and for insurers to determine reimbursement at a much higher level of detail.
The delays have been both a blessing and a curse for South Nassau in that they allowed for better preparation by those organizing the transition. However, delays made it harder to maintain momentum with physicians, many of whom gave up on the idea that the transition would ever really happen, adds Colleen Garvey, RHIA, South Nassau Communities Hospital’s administrative director for health information management and clinical documentation improvement.
Key points of preparation
Like many systems, South Nassau has utilized a hospital steering committee as its command center and has been through multiple phases of preparation with each delay, re-assessing and improving upon their systems each time.
The efforts—and expenses—have been high, including hiring new coders, training staff, upgrading computer systems, installing new systems, etc.
“It’s been a major cost from an IT infrastructure perspective,” Garvey notes.
Rosenhagen highlights their adoption of the 3M 360 Encompass System. They had already begun using the 3M HDM System, and bringing in the 3M 360 Encompass enabled them to use all of the data that resides in their EMR as well as potential external data. The system takes the text and converts it into ICD-10 codes “so it becomes a matter of reconciling and validating that the record is accurate and speaks to the codes that were collected during the patient’s stay,” he says.
He adds the hospital has been looking at concurrent coding and computer-assisted coding functionality to develop codes while patients are in the hospital, transferring information to the coder when the patient is discharged.
In addition, South Nassau has four nurses trained in clinical documentation improvement who are communicating with physicians when queries are generated due to information being insufficient or unclear. That process enables the hospital to validate the performed activity.
While they did have a version of this process before, “[w]hat tied everything together was bringing in the 3M 360 Encompass software,” Rosenhagen says. The installation took over a year and was planned and executed after the first ICD-10 delay.
“The delay gave us breathing room to go back and assess the system further,” Garvey adds. However, while the delays allowed more time for assessing and testing, the delays also had their downsides.
“We lost momentum and focus from the providers,” Garvey says. She notes after the news of the most recent delay, it was like they shut down. “Trying to get providers to take it seriously at that point was a really big challenge,” she says.
Some physicians are just coming out of the woodwork now, Rosenhagen adds. “We’re getting calls from doctors [asking] when is their ICD-10 training – we’ve been providing it for two years,” he says.
Another aspect of preparation has been working to ensure their large volume payers are ready to accept ICD-10 codes. While those plans are in place, there is still uncertainty about their low-volume payers, Garvey says.
Doomsday in perspective
The planning now comes down to ongoing monitoring and training, Rosenhagen says. While no major disasters are predicted, the hospital does have contingency plans in place.
The hospital is now doing risk mitigation work to ensure their cashflow and accounts are monitored and has contracted resources on-call in case of impacts and delays on the productivity side.
The most dire advice that Rosenhagen has heard is hospitals should have a cash reserve on hand to cover six months' worth of operating expenses in case of issues with reimbursement.
“Nobody’s going to have that,” he says. However, he's confident if hospitals are impacted, provider groups and professional associations will be able to call for a safety net payment structure. That would allow hospitals to get paid based on historical data and for a reconciliation to take place at a later date. “Hospitals can’t be held at risk,” he says.
“I think October 1 is just a new beginning, a new chapter," Garvey adds. "It's not the end, and training will be ongoing.”
A consultant's view
David McCann, a managing director in Berkeley Research Group's Clinical Economics practice, has seen similar concerns and experiences to that of South Nassau Communities Hospital while working with clients to prepare them for the upcoming transition—including difficulty resulting from last year's delay when many providers gave up on planning.
“I think most places have been pretty good about getting their coders up to speed and using resources so they can code accurately in ICD-10, but they're behind the eight-ball now with the physician training."
McCann suggests most of the difficulties in the transition will be worked out but it is going to take some time, and warns there will be impacts to productivity.
At this point, his advice to hopitals is to shift their main focus to monitoring the situation and auditing their records and coding work. "It's really not a situation where once it hits we just live with it," McCann says. "It's going to take ongoing monitoring and education, and making sure the hospitals are getting the most out of it."