The era of ICD-10 has begun for the U.S. healthcare industry. Now comes the task of improving performance.

Many healthcare organizations have measured their performance before ICD-10, and they’ll be tracking key performance indicators to determine the actual impact of ICD-10 on operations. Large deltas in performance will help organizations know where attention needs to be paid to achieve needed improvement.

Health Data Management recently convened a panel of hospital experts, and they shared how they plan to achieve performance improvements after October 1. With questions posed 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: In considering how to increase proficiency with ICD-10, how should an organization plan to improve in its use of the new coding system? What are some organizations planning to do to achieve continuous quality improvement?

Debbie Schrubb: We’re an Epic client and we’re using the diagnosis calculator. So when they're trying to translate one code into many, the diagnosis calculator walks them through it.

That's what we've been doing for a good six to eight months. I know some clinicians have chosen the non-specific codes, but at least they know they have access to ICD-10 codes. We’re also setting up a coding hot line they'll be able to call and ask us those questions so we can help them with specificity. Our clinical documentation staff already started doing ICD-10 queries in August.

Jean McCammack:   We've done cross walks and also have some ICD-trained coders helping us. We look at both sides to see the change from the ICD-9 to ICD-10, so we understand what the transition does impact. Beyond that we’re providing as much support as we can for those clinicians.

Bazzoli: How will incorrect EX codes on scripts be handled for lab and radiology walk-in services?

Schrubb: Interesting you should ask: We've been working on that initiative for the last month. We’re going to take the order on a temporary basis--hopefully for only three or four weeks--and we have a whole team of people on the admissions side to work with those practices. If it’s during business hours, we will contact the practice and try to get a corrected order. If it's after hours, we’ll do the follow-up process. If a practice doesn’t cooperate, it will be escalated to our executives and medical staff leadership to have those conversations.

We also know that some of our patients are going to walk in on October 1 and the days after with an order that a physician wrote six months ago with ICD-9 codes on it, and it's not the physician's fault. We're going to do our best to accommodate our patients.

Bazzoli: Besides monitoring coder productivity, what about doing QA to measure quality and accuracy? Is that something that any of you are pursuing?

Schrubb: We are going to do quality audits every single day and look at those coders who are struggling. The coders that we now know are doing pretty well, we'll do less auditing on them.

McCammack: We're doing the exact same thing. We have that process set up in the ICD-9 world, and it will continue with ICD-10.

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