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Embracing the benefits of ICD-10: Rochester Regional Health

Diana Adam-Podgornik worked 20 years in the aviation industry, but was displaced after 9/11. She went back to school for a degree in Health Information Management, obtained her Registered Health Information Technician (RHIT) certification and then became employed at Unity Hospital in Rochester, New York.

In the last year, her health system merged with the former Rochester General health system, and it became Rochester Regional Health. In the process, the new system obtained a couple smaller regional hospitals, so now the system has five hospitals under its umbrella, as well as six living centers, seven adult day services facilities and numerous physician practices across the areas of orthopaedics, geriatrics, pediatrics, obstetrics and gynecology, endocrinology and more.

Her current role as Coding Compliance Coordinator does not accurately describe the totality of her work. She acts as the liaison between HIM and Patient Financial Services, handling backend denials, medical necessity and Advanced Beneficiary Notice (ABN) processes. She also served as a liaison to her system’s living centers and when Rochester Regional Health began to put together a committee to vet vendors for ICD-10 educational purposes, she was asked to become part of the educational team. Later, she was responsible for either choosing educational content or customizing content and then meeting with all of the supervisors and management leaders in the various interdisciplinary departments of her system to enroll their staff into some type of education in preparation for the ICD-10 go-live. That has been Adam-Podgornik’s key role as Systems Administrator for the last 18 months.

In short, she is like many other amazing healthcare administrators in America working on the front lines of the ICD-10 transition.

I had the opportunity to speak with Adam-Podgornik to learn more about her preparations for ICD-10 and how Elsevier has served to assist her efforts. 

(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article. This interview is part one of a two part series. Part two will be published January 4, 2016.)

Free: Please take me back a few years and describe the vibe – the angst, or the relief, whatever emotions may have been evident to you at the time – when the healthcare industry realized that ICD-10 was definitely becoming a reality in the United States. 

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

Adam-Podgornik: Well, as a HIM professional, I was excited, along with my co-workers in my department. We understood the value that ICD-10 is going to bring, not only to the role that we play in the revenue cycle, but also as far as the reports that we generate for the health system and for other outside agencies.

That being said, there was a little bit of trepidation because we understood the expansion of the codes and the amount of time it might take to learn and incorporate them. It was going to be a steep learning curve, so there was a little bit of a fear factor there. But ultimately, we were excited because, again, we saw the value in it.

 As far as the health system, I think there was two things that I saw sorta stand out. There were the naysayers that said, “Oh, it’s never coming, and I really don’t have to do it, and it’s not going to be that difficult. I already capture everything and I can do it in 8 minutes I just really don’t need to prepare.” And, there was those that wanted to wrap their heads around it, but had kind of the deer-in-the-headlights because they didn’t know where to start. They were looking for some kind of guidance as to how we would manage the preparation in order to become prepared.

Free: What would you account for the industry’s trepidation? 

Adam-Podgornik: First of all, we’re a major leader globally, and we’re the last industrialized nation to move to ICD-10. I think that’s a shame. I wish that we would stop all of the red tape and the bickering back and forth about, “Should we do it?” “Should we not do it?” “What’s the benefit?” “It’s a lot of change and a lot of cost.” It’s been a lot of this and that, back and forth. Just separate the weeds. Get down to the real story, and make a decision.

But, like with anything of this scope and scale, we get mired in that negative mindset and it’s becomes a really slow journey. We didn’t get down to the truth as to “What do I need to get prepared?What is the real cost to my facility, or system, or self, or whoever, whatever?” and really commit to make a plan. I think because there was a lot of starts and stops with the date of implementation, that just added to the angst and confusion in really getting the ball rolling.

 I know that even in my facility when we started way back in 2013 and when it came closer to 2014, a year or so into it, it was like, “Oh no. Now we’re delayed. How do we keep the momentum going, but also maybe have time now to add another layer to it that will help with some of the naysayers and denial-bound people that are just thinking that it’s never going to happen? How can we now bring them into the funnel, turn them around, and make them realize that it’s not just about codes, it’s about good documentation. It’s about patient care and patient safety.”

Physicians often said, “Oh, well, it’s all about my money.” Well, it sort of is, but it’s also about your quality measures and the way that your peers are going to look at you and the way your organizations are going to look at you. It’s a lot more than about documentation and codes.

Free: Let’s continue talking about your particular facility. If you could take me back to the very beginnings, what were the initial considerations, and who were involved in the decision-making processes relative to your staff’s transition to ICD-10?

Adam-Podgornik: We started planning by determining a steering committee, a group of high-level stakeholders, to determine how to tackle it. We had to answer first some basic questions like: What kind of budget should we put together? What types of teams should we create? From there, we developed a core team. Within that core team, which was interdepartmental. We had members working together from IT, revenue cycle, HIM, our large lab system, financial risk management, as well as communications and education.

As team members, we started planning, again ensuring that our stakeholders understood what we wanted to do, what our direction was, and how to work towards that goal. We then began vetting educational vendors when we determined that we didn’t really have anyone in-house that we felt could handle the breadth of education that we needed with the number of employees and staff that we had.

 We brought three different vendors to the table. Elsevier was our eventual choice, and from there, I worked with them on the install and deciding on how to run the platform and things of that nature, while another part of that team ran a gap analysis within the health system. Once the platform was in place, HIM and our clinical documentation specialists were the first group that were up on it, just to give myself a chance to understand how the system ran and really become familiar with it.

I used my own co-workers kind of as guinea pigs, which they sometimes appreciated and sometimes didn’t. They absorbed around 100 different lessons that the Elsevier program provided, which was a great experience for them because I really feel that they got a solid education out of it. Then we made a plan to address additional questions such as, how does our training have to be rolled out? What groups should be included and in what order?  What kind of content do they need?

At the same time, we were also looking to update our systems, work-through processes and workflows and create interface matches. Farther down the road, we began considering creating things like sandboxes to get people to start practicing, to start to dual code, and then go through testing with our payers. Things of that nature.

So that’s the journey that we took until we got to where we are today. At this point, we’re in the last days until go-live, and we have our sandboxes created. We were recently still working with some of our interface clean-up and payer testing, but our coders have been dual-coding now for a good ten months. We pulled the physicians into the sandboxes to bring their problem lists up to date, and they’re practicing with ICD-10 codes as well. So I think we really have a good game plan in place. We are as close to being ready as we can be. I credit our progress to our teamwork, our planning and our vendor partners like Elsevier.