We reached the finish line for ICD-10: Now the race really begins
Well, it is finally happening.
Many, including myself, doubted that ICD-10 would ever be mandated in America. Of course, we knew it was going to happen, but, like a freshman in high school considering graduation, it seemed like a distant event that’s difficult to comprehend as a reality.
With ICD-9 coming to an end, I decided to contact Amy Amick, President, Revenue Cycle Management and William Davis, Vice President, Revenue Cycle Advisory Solutions at MedAssets to get their thoughts regarding our industry’s less-than-smooth transition to ICD-10.
(Editor’s note: This interview is part one of a two part series. Part two will be published November 30, 2015.)
Free: After all the talk for so many years, and after many delays, ICD-10 is finally taking hold in American healthcare. Could you both give your perspective of what went wrong in how the roll out was handled?
Amick: Something that’s very true across the entirety of our healthcare space is that there is fragmentation, and with that fragmentation comes the opportunity for clinical challenges, financial waste and great inefficiencies. So, when I think of the challenges with ICD-10 and the false steps in the efforts to get it operating here, I see it more as just a microcosm of the healthcare industry in our country.
When you’re going from a certain number of codes to an exponentially larger number of codes, the realities of that magnitude of change are tremendous impacts to clinical care and reimbursement efforts. Then when you consider how those impacts are being placed into an environment that is inherently fragmented, that becomes the source of the delays, conflicts and challenges that have made it difficult for our industry to be ready and able to adopt a change like ICD-10.
Williams: Amy, to add to what you said, I think it’s more the complexity of the systems that we use and inherent with that, in terms of great change, comes fear, uncertainty and doubt. It’s just the fear of the big unknown. Obviously, we haven’t incorporated anything like ICD-10 and that is scary for a lot of folks in our industry.
What could we have done better as to not cause the delays? I think it comes down to training and education. Certainly, just having more familiarity on what the impacts of ICD-10 will be, and having a point of view or a comfortableness with that, would ease the transition. So now, going in to your second point, there has been an extra year. I think the extra year has been used, in some cases, wisely in achieving that level of familiarity.
Getting back to what Amy just said around the fragmentation in our industry, I think some of those parts are starting to come together. Entities, payers, providers, technology, vendors all started to come together through this past year and they have much more of a familiarity of what this impact may be, and I think this past year of work absolutely will make the transition much easier come October 1.
Free: What are the special challenges that either a larger organization or a smaller organization have to undertake to get ready for ICD-10?
Amick: With any large-scale change, and ICD-10 is clearly a great example of that, you have to be prepared on a people, on a process and on a technology perspective. Proper planning equals greater ease of being able to prepare, and to have resources, for change.
Whether you are a one physician practice, whether you are a hundred hospital system, the things that have to change are exactly the same. How do you think about your people from a training readiness perspective? How do you think about your processes and workflow? What stays the same? What needs to be modified? And lastly, your technology and your enabling tools that support your people and processes; are they ready, or do they need to change as well?
Williams: I think some of the larger organizations, specifically talking about hospitals, are in a slightly better position for these sorts of changes. Yes, they’re thinking about their technology, processes and interfaces into the payers, but some of the smaller facilities, I think, run into challenges of not necessarily having the ability to scale up like some larger organizations can.
A great example of that instance is clinical documentation improvement (CDI). I have seen estimates of about 20 percent of small practices that still do not have a formal CDI program in place. They may have clinical documentation specialists, but they have no formal program in place and that is critical because clinical documentation is such a key component of any successful ICD-10 transition. Almost every large organization has a successful CDI program in place along with their specialists. So, it is really not a one size fits all, Jason, to your original point. It is more of a tailored approach, and I do think the smaller facilities will have a challenge of formally implementing some of those processes to make sure there is a smooth transition.
Free: What’s going on with the payers right now, or what should have been going on with the payers, up until this point in time?
Amick: Whether you’re a provider or whether you’re the payer, you’ve got to do the same things. In order to get ready for a change like this, you need to think about your inputs, your outputs, your tools and training and everything else that sits with it. You have to think about a change like this from a 360 degree perspective.
You must take your current understanding of the inputs that are coming into your systems and processes. Then you have to make sure that you are adjusting your systems and your content that resides within your systems. You have to appraise and adjust the readiness of your people and your workflows. And then you have to have your outputs ready and able to go to whoever’s receiving them. It’s the exact same steps, framework, etc.
Williams: The Workgroup for Electronic Data Interchange (WEDI), released a report in March of this year that cited about 7/8ths of the health plans were complete with internal business process design and development. Using that as a point of reference, and also looking at the testing they’ve done with the providers to date where they are citing about 4/5ths of the health plans have started internal testing and are actively testing with providers, our point of view is that payers are ready. They have actively engaged in not only the remediation steps, but also external testing with providers as well.
Again, I think the extra year that both payers and providers have been afforded has gone to a large part of making sure that that testing is as widespread as it can be. With such testing in the books, we believe the transition will have more successes than problems.