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October was Just the Beginning: Moving Forward with ICD-10

For most in healthcare, ICD-10 was the ticking time bomb that never went off. What began with years of delays and blasé attitudes, ended with raising anxiety growing to such intensity that the industry collectively seemed to plug its ears and squeeze its eyes closed tightly as the calendar counted down to October 1, 2015.  

In my first interview with Diana Adam-Podgornik, we learned how Rochester Regional avoided the angst and anxiety most the industry felt and instead how they planned and prepared for ICD-10. For our second interview, Adam-Podgornik describes in detail how one of its vendor partners, Elsevier, served as a vital member of her organization’s ICD-10 transition team. 

Diana Adam-Podgornik
Diana Adam-Podgornik, Coding Compliance Coordinator, Rochester Regional Health

Free: Please describe the learning curve your staff experienced prior to the ICD-10 deadline and some of the benefits that you’re seeing since October.

Adam-Podgornik: As an HIM’er, I’m all about ICD-10. I’m all about codes, documentation and medical records standards, so I was eager to take on the change. For others in our health system, however, the learning curve was a bit scary. There was some push back from some areas when we began really tackling the transition away from ICD-9.

The key was knowing who our target training audience was and determining ahead of time who needed what as far as educational content. We had to identify who is really touching, pushing, pulling, entering and analyzing codes or documentation. That group required a bump in their level of learning and they needed a little deeper dive into education. You had peripheral staff that just needed more awareness. They needed to be able to understand that if they heard someone talking about the change that they knew a little bit about that subject. You don’t have to know everything, just that it’s out there.

As far as a push back with folks that needed a deeper dive, it was just saying to them, “Yes, we’re moving to 75 thousand, or however many thousand codes, but that doesn’t mean you have to know all of them or memorize all of them. You still are just going to take the codes that you work with everyday and, eventually, build yourself a nice library of how those map to ICD-10, and concentrate on those codes. Take your top 10 codes and work through with your team to map them to ICD-10 and that’s what you’ll concentrate on and learn about and learn to document against, and kind of go from there.”

We also stated the ramifications of taking on this transition well is that any reports that you’re going to pull from that information are going to be that much better, so it’s the old adage “Garbage in. Garbage out.” How well you determine those codes and document for those codes is how well your reports are going to be on the other end. That angle was one that most of our staff instantly recognized and then dropped their initial skepticism. 

Free: Please describe Elsevier’s relationship with your staff. During the vetting process, how did they separate themselves from the other vendors, and were there some things that you didn’t anticipate that a vendor could help you with?

Adam-Podgornik: They separated themselves by just being no-nonsense. That’s what we were really looking for. Enough with the bells and whistles and game playing. They were really just genuine, down-to-earth straight shooters. They knew their product, and they believed in their product. They are a globally-known vendor. It just made a lot of sense. It was a good fit for our facility.

I don’t want to downplay the other vendors who we were vetting as well. They’re good in their own right, it’s just they weren’t the proper fit for us. The decision depends on your facility and what you’re looking for.

Once we actually got in, our Elsevier sales rep was just wonderful and available at any time. I was also surprised that their customer service reps were able to handle so many of our issues. Whenever I had a problem, someone at Elsevier was there to help me even down to the tiniest thing like a learner needing a little tweak in the background or helping me articulate to my own IT team what I needed on my side vs. their side. It’s been a pleasure working with such a supportive vendor.

Free: A lot of people were looking at October 1st as many did with Y2K.  Regardless of its immediate impacts, ICD-10 really just started in October. What are your plans moving forward through 2016?

Adam-Podgornik: Our contract with Elsevier extends six months after our go-live, at which time we can then take a look at where we are and determine our next step. We intentionally built in that overlap. 

We set up a command center, so that we can field calls for people that hit the panic button. I hasn’t been too big of an operation for us just yet, but you never know about the future. We still are somewhat of a hybrid facility, so we have mostly electronic system up in 95 percent of our departments, but we do have a couple of siloed areas that are still on paper, and I think it may make it difficult for them as they’re kind of cutting over, so they have like their toe in the water and that workflow process is what I see as two areas that may be a bit problematic.

Also I think we are going to see how well the physicians really paid attention to their education. They may have all academically done well on the ICD-10 learning modules that we gave them, and now that they are getting down to really documenting on it, we’ll see how that goes. We plan to really just be buckling down, and so our Elsevier contract that we have in place will help us determine who needs a refresher, and again, people that are just coming in. Should they take it? How much do they need? What role do they play? We’ve planned well in that area.

I just want folks to know out there, I can just talk a little bit about the Rochester community and that what I hear, even state-wide in some conventions that I’ve been at in the last year or so, is that facilities that are smaller, that don’t have budgets like larger health systems or hospitals do. I think the ones that are more fearful and behind the eight-ball a little bit. Really, my advice to them is that it’s not too late. Even taking baby steps and just going out to different publications like yours, who have great articles out there that talk about this and what they can expect and give them hints on planning. If they go to the CMS website, there are all kinds of resources that are still out there, and really to reach out to other members in their communities that they may not realize are farther along than they are. In my mind, it’s a national initiative. We’re all starting from the same starting point, and we all have the same end game. So there’s no mindsets of this is mine and I can’t tell you about it. We should all be sharing everything. Pick up the phone. Call your friends. Call your contacts. They can help you with resources or talk to you about what they know or what they’ve learned or whatever to help get you going. It’s happening, it’s a great thing, and I’m excited, and I’d like to see everyone succeed. 

Elsevier, ICD-10, Rochester Regional Health


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