A key to success with the ICD-10 transition will be the ability of organizations to identify potential problems before they occur. Success in proactively finding issues can save organizations time and money.
Health Data Management recently conducted a web seminar on final preparations for ICD-10. Topics covered in the seminar provide important suggestions for providers getting ready for October 1. Moderated by HDM Editor Fred Bazzoli, those participating in the seminar included:
- Aaron Miri, CIO at Walnut Hill Medical Center.
- Jean McCammack, Chief Quality Officer at Walnut Hill Medical Center.
- Debbie Schrubb, Corporate Director of Health Information Management and Kettering Physician Network Coding at Kettering Health Network.
- Stephen Stewart, Interim CIO at Schuylkill Health Systems in Pottsville, Pennsylvania.
Fred Bazzoli: What are you doing to identify potential transition problems over the next few weeks? Are you looking for any particular red flags that may have not been anticipated? It sounds like having clear lines of communication is central to your efforts. What kind of things are you doing there?
Jean McCammack: We're conducting significant staff education, trying to make sure everybody's familiar with the language, so that if, for example, a physician does have a question and doesn't know who to ask, we can direct them to the people that can help them.
We also meet, almost on a daily basis, to look at any issues that might impact this. One interesting issue was with the company that insights our PICC lines: they needed more specificity for their documentation based on the fact we use those lines for fluids and transfusions.
Aaron Miri: A key point to consider is ensuring you have physician champions. You need a leadership team that is united in the message about the importance of improving documentation. Physician champions, especially on the hospital side, need to advocate to the various specialties and service-side doctors about why there needs to be more specificity in the medical documentation, why orders need to be clear and signed, and why, for example, the lateral aspect of the documentation is critical.
Stephen Stewart: You would think at this late date there wouldn't be anybody still in denial that this was really going to happen, but there is. So we’ve been trying to stress the economic imperative of making this transition, and convincing staff it’s not an attempt to intimidate them into cooperating and complying with the effort. You have to wake some people up and make them understand this is really going to happen. Our physician population is largely independent--we employ between 20% and 25% of the physicians--but they're responding pretty well.
Another part of our effort has been reaching out to the office staff at independent practices as well as their clinical support such as medical assistants to ensure they're on board. We’ve had them involved in the training process so they be an extension of the support we’re providing during the transition process.
Debbie Schrubb: We're ensuring that we're staying as current as possible with our ICD-9 coding so that when October 1 rolls around, the coders can move forward and stay focused only on ICD-10 and not have to worry about doing any dual coding. If they stay focused on those sets, they're going to be much better off and hopefully quicker to adapt than we're anticipating.
We’ve also prepared ourselves to track coder productivity every single day when we start coding in ICD-10. We’ve determined it would be a real problem if we make the transition and don’t have a sense if the coders are gaining momentum. If we can’t track daily performance we could very quickly find ourselves in a backlog situation that who knows how long it would take us to recover from.
Stewart: I’d like to add that that’s a really great idea because it helps identify quickly those who are struggling and where to provide more support or assistance to get up to speed. We think all our coding staff is ready, but there are going to be some who struggle.
Schrubb: You're exactly right. I have three coding business analysts whose responsibility will be to monitor that productivity and know who's struggling. They’ll be able to reach out to coding staff immediately so we can pinpoint what their transition problems are so we can educate them on the spot.
Stewart: And help them overcome the fear, because there is a lot of fear, uncertainty, and doubt right now.
Schrubb: Agreed. On the other hand, some of our staff are really excited about the change, I’m happy to say.
Stewart: It spans the spectrum, but there are some coders who are pretty concerned that their years of exceptional performance are in jeopardy now. If they just believed in themselves as much as we believe in them, they would be a lot better off.
Bazzoli: Do you get any sense that moving from a test environment into “this is life as we now know it” mode will be difficult for coding staffs?
Schrubb: I don't think so. Our group has been training for almost two years, and we've been very diligent about making sure they’ve had time to practice ICD-10 coding. I think they've had enough time to build that confidence, and we’ve also made sure when someone's doing a really good job we're sharing that with them and sharing it with their teammates.
So, from that perspective as long as you're letting them know they're doing a great job, and helping those who are struggling, you’re making sure that whatever issue comes up, they know you’ll spend the time to help them work through it.
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