Date: 8/7/2013
Title: The Transition to ICD-10: Building the Bridge as You Walk on It
Presented By: Christine Kalish, MBA, CMPE, National Practice Director, Strategic Advisory Group of Beacon Partners
Description: With the transition to ICD-10 only 15 months away, organizations will have to find inventive ways to create their roadmap and execute on their plans. Rather than taking valuable time to complete a gap analysis and then create the plan, organizations should consider how to do these tasks concurrently.
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Beacon Partners / BridgeFront ICD-10 Webinar: Building the Bridge as You Walk on It
1. The Transition to ICD-10
Building the Bridge as You Walk on It
Presented by: Christine Kalish, MBA, CMPE,
National Practice Director
August 5, 2013
2. Heading – Ariel 40
• Get up to date on ICD-10
• Define key strategies in the transition
• Realistically identify work to be
accomplished
• Identify assumptions and constraints for
the program and related projects
• Create your organizational structure
• Use resources and partners effectively
• Questions
2
Agenda
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• Fifty percent of health plans will begin testing by the end
of 2013
• Fifty percent of providers didn’t know when testing would
occur
• Two/fifths of providers had no idea when their impact
assessment would be completed or their business
changes made
• Two/thirds of vendors will begin customer review and
beta testing by the end of 2013
• At least forty percent of entities delayed their timeline by
at least 6 months
4
Industry Readiness - Current Facts
WEDI 2013 Survey
Time frames have shifted
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• Denial rate increase from 10% to 25%
• Backlogs – 64 days to 6 months
• Billing delays
• Payment declines > 2 years past the implementation
• Thirty to fifty percent decrease in coder productivity
• > 10% of charts lacking sufficient specificity in
documentation
• DRG shifts
• Over-coding due to lack of experience – results in
RAC audit
5
ICD-10 Revenue Cycle Impacts
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7
ICD-10: Competing Initiatives?
ICD-10
Meaningful
Use
Organizational
Monitoring and
Performance
ACOs and
Medical Home
HIEs
Quality
Reporting
Initiatives
Research
Payment
Reform
Value-Based
Purchasing
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• Practice and/or hospital acquisition
• Achieve compliance by October 1, 2014
• Educate providers
• Enhance quality through MU Stage2
• Stay solvent
• Retain coder and CDS talent
• Create alignment with community
providers
• Reduce negative impact to cash flow
8
Organizational Strategies and Goals
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10
Quick Look: ICD-10 Gap Analysis
• ICD-10 – Not Just an IT Project
̵ Codes live everywhere in the organization
̵ The gap analysis is designed to understand where codes are
currently utilized in the organization
• Gap Analysis Designed to:
̵ Determine areas and roles where codes are utilized
̵ Determine processes where codes are utilized
̵ Complete software inventory, vendor query process, and
impact analysis
̵ Complete outline of training and communications plan
̵ Understand financial impact of the transition
• Challenges and Opportunities:
̵ Communication of practice-wide impact
̵ Role-based workforce education
̵ Updating processes and software
̵ Assuring revenue neutrality
̵ Determination of financial impact
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• Processes and departments
̵ Revenue Cycle
̵ Quality
̵ EHR tools
̵ Clinical Documentation/Chart audits
̵ Non-IT Project management
̵ IT
• Entities that can be out of scope
̵ Retail pharmacy
̵ Wellness Centers
11
Define the Scope
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12
Technology Assessment and Reporting
EXTERNAL REPORTING ICD-10 HIGH-LEVEL IMPACT DASHBOARD
Department
ICD-10 Impacted External Reports
Yes Unknown Indirect None
Cardiac / Stroke 1 2 0 3
Diabetes Education 0 0 0 1
Family Birthing Center 2 0 0 1
HIM 1 0 0 3
Home Health 1 0 0 0
IT 1 0 0 0
Joint Program 1 0 0 0
Oncology Program 1 0 0 0
Patient Financial Services 2 0 0 0
Quality 3 0 1 4
Radiology 1 0 0 0
Trauma 1 0 0 0
TOTAL 15 2 1 12
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14
Key Financial Dashboard Metrics
Metric Information
Accounts
Receivable
A/R days by payer
Aging of open A / R days in dollars
First pass resolve
Number / type of rejects / denials by payer
Number of claims pending for additional information
Liability insurance rejects
Mismatch – hospital / physician data
Case Mix Case mix index
DRG shift
DRG shift by service line
Clinical
Documentation
Queries to physician
Response to queries
Query response time
Query agree / disagree
Query backlog
Query versus chart review percent
Coding and
Billing
Coder productivity rates
Coding accuracy
Discharged not final billed (DNFB)
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• ICD-10 affects every department
• Develop communication plan
• Staffing
̵ HIM/ Coding
̵ Patient Financial Services
• Training Strategy
̵ Documentation for all audiences
̵ Types of training – online, lunch & learn, etc.
• Train the policy and procedure changes
15
Training and Education
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16
Organizational Capability
Current State Roadmap to ICD-10
Executive Sponsorship for the ICD-
10 Project is in place.
ICD-10 requires high visibility and support to guarantee a successful
transition. Continue to assure that Executive Sponsorship is strongly
maintained.
ICD-10 Steering Committee is not
yet formalized.
Formalize Committee membership and charter; establish regular meetings;
increase visibility; drive project toward goals.
Work groups have not been
formed to accomplish ICD-10
related tasks.
Formulate work groups under the Steering Committee Charter. Establish
task lists and regular meetings to tackle tasks and implementation
challenges.
ICD-10 requires dedicated
resources for project.
Hire or retain an ICD-10 experienced project manager to drive progress
toward a successful code set transition.
Move to new hospital slated for
May 2014.
Review IT resources for both move and ICD-10 remediation of all systems.
Supplement IT resources as needed.
Lack of “physician champion” to
assist in communicating the
significance of the transition to
ICD-10.
Appoint one or more ICD-10 project “Physician Champions” to spearhead
the provider education and training process to ensure momentum in this
area and that provider needs are being met.
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• Define the areas of analysis and focus
• Complete your analysis at a high level
• Workflows – reference the EHR
• Take descriptions of workflows at face
value
• Develop budget with assumptions from
prior history
• Systems and applications inventory – use
information from the vendor
18
Project Assumptions and Constraints
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95, 78
%
27, 22
%
Do you know what ICD-10 is?
Yes
No
19
What do your providers know?
A total of 165 faculty members were surveyed regarding ICD-10. Thus
far, 122 have responded, for a response rate of 74 percent.
86,
70%
36,
30%
I know that I will have to code my
billing encounters with ICD-10
codes by October 1, 2014
Yes
No
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• Steering Committee and Workgroups
̵ Plan the strategy
̵ Create overall project plan
̵ ICD-10 Steering Committee
• Multi-disciplinary
• Able to make decisions
• Fluid
• Workgroups
̵ What areas are affected?
̵ Identify current teams and committees
̵ Do the affected areas have a plan and timeline?
21
Organizational Structure
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22
ICD-10 Workgroup Structure Across the Enterprise
HIM
Inpatient
Departments
Information
Systems
• Software
• Interfaces/
Extracts
Managed Care
Ancillary
Services
Outpatient
Clinics
• Internal
• External
Training & Education
Communication & Marketing
Revenue
Cycle
Management
SAH
Physicians
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• Focus on patient care, documentation, and coding
• Promote and expand your clinical documentation
initiatives
̵ Use training, software, and Clinical Documentation
Specialists
̵ Automate prompts and templates
• Educate your providers
• Lay your metrics as a base, and then monitor for:
̵ Improved patient assessment
̵ Improved clinical documentation
̵ Improved coding
̵ Improved information
̵ Improved outcomes and improved business
25
Strategies for Physician Work Structure
ICD-10-CM: The Case for Moving Forward, Joe Nichols, MD
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• Incorporate work into already existing
teams
• Use on-line survey tools
• Leverage existing inventories and work
partners
• Correspondence – use RFIs for vendors –
applications, managed care contract
partners, patient financial services and
business office
26
Leverage Existing Infrastructure
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• Safety net hospital with 151 beds
• Appointed strong internal PM
• Clear direction from Executive Leadership
• Conservative approach – limited dollars
• Utilize strong partnerships
̵ Revenue cycle management
̵ Clinical documentation
̵ IT – system specific
• Identifying each focus area and assessing
28
Case Study
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• Identify your physician champions now
• There are no shortcuts, just opportunities
• Continue to expect the unexpected
• Identify areas for
standardization, centralization and increased
efficiency
• Communicate, communicate, communicate
̵ Keep senior management informed to remove
roadblocks
̵ Work for senior management support and buy-in
• Leverage everything you can –
people, processes, and technology
• Think outside of the box
29
Take-Aways
32. Thank You
For more information
please contact:
name@beaconpartners.com
1.800.4BEACON │ BeaconPartners.com
BOSTON · CLEVELAND · SAN FRANCISCO · TORONTO
32
For more information please contact:
Christine Kalish
ckalish@beaconpartners.com
33. Heading – Ariel 40
ICD-10
• Developed and manage the ICD-10 service line, which includes assessment
processes and toolkit development, knowledge transfer and training.
• Completed a modified gap analysis for a hospital system in Texas, providing
guidance and oversight for planning and implementation efforts, which include
project plan and dashboard development.
Served as team leader for a revenue cycle project that mapped the
revenue cycle for a $50 million clinical enterprise.
• The team developed KPIs, identified training opportunities, and additional
opportunities for performance improvement.
• The team provided workflows for all processes and utilized fish bone analysis to
identify work process improvement and develop training.
Mapped the revenue cycle process flow for a $2.6B health
system, identifying documentation requirements for the IS
operations.
• Developed the documentation process, forming a working committee to identify
all supporting documents and process to support the change management, design
and implementation process as systems are upgraded, replaced and made
compliant for Meaningful Use, 5010 and ICD-10 and as other facilities are added.
33
Christine Kalish, MBA, CMPE
Christine Kalish
National Practice Director, Strategic
Advisory Services
M. Christine (Chris) Kalish is an accomplished healthcare
executive with 25 years’ experience in ambulatory care
and academic medicine. She has served in senior
leadership positions in large academic medical centers in
the southwest. She leads strategic planning
efforts, process improvement projects and business
assessments in all areas of the clinical practice, as well as
developing business opportunities within the
community. She has exemplary skills in researching and
resolving operational, financial, productivity and staffing
issues. Ms. Kalish understands the unique opportunities
and challenges in an academic practice and the majority
of her experience over the last ten years relates to
academic medical centers and relationships with county
/ safety net hospitals. She is a systems and strategic
thinker with strong problem-solving and organizational
skills. She is accustomed to building relationships with all
levels of leadership and staff..
Notas del editor
In 2012 all health plans expected to begin testingSimilar to the last survey
No ShortcutBig investments on toolsCAC and CDITranslation toolsTrainingBarriers/ challengesDecreased cash flowLess efficienciesIncreased workload along the revenue cycleBig bang implementationLong learning curveProcessing and service issuesRemediate all applications, reports and interfacesRely on providers for cash flowPayers use sophisticated analytics – laying groundwork for future reimbursement rules and rates adjustmentsSignificant areas of riskClinical documentationPhysician preparednessCompeting prioritiesResourceDenials managementDept workflow changesVendor application readiness
Stay focused
EHR implementationsMergers and acquisitionsMeaningful Use AttestationICD-10
Enhancing clinical documentation programs and toolsMove to ACO structurePatient Centered medical homeMove to bi-modal billing
Define project resource requirementsProvide instrumental project leadership, including the development of work plans, timelines, and keeping projects on taskReport and communicate project status to ICD-10 steering committeeIdentify and remediate project risks as they emergeMaintain client relationships throughout the project by apprising clients of project progress on a regular basis, initiating and maintaining contact with other key project individuals for clarification, coordination and negotiation of critical issuesCommunicate project status on a regular basis to management and maintain a repository of project documentation
Develop inventory of systems, applications and provide risk analysisEstablish vendor and agreementsIdentify system upgrades and replacement requirementsDevelop testing plansExtensive testing is needed with interfaces, claims files and GEM crosswalksTesting Needs AssessmentSystems Risk Analysis Assess readiness and “red flag” potential issuesFunctional features impactsData and process interactionsDetermine the testing scopeTest planning and strategyEnterprise Testing PlansBy vendor/application and roleOperational risksStakeholder involvement – roles and responsibilitiesTimelines and milestonesResources and expertiseApproach- dependent on the riskRemediation or replacementNeutralizeHybridPrepare the environmentImplementation MethodologiesCreate comprehensive test casesPositive, negative, boundaries, real worldDeveloped with IT, payers, end users, business unitsProvide a mixed strategyTranslate historical claims- review historical billing patternsBuild a set of test claims coded nativelyRegression, integration, end to endExternal interfacesVendorTest ExecutionVertical or horizontal testingFind ways to automate creation of test data and decrease manual interventionRemediationExisting custom and external reportsPopulation, quality and analytics dataClinical data (encounter forms, EHR pick lists, etc.)Analytics to Validate ResultsTranslation and business processesWill provide information on Operations readinessClaims transparencyFinancial neutrality
Fiscal ImpactsWhat is the financial impact if revenue drops by 40%?What is the financial impact if AR days increase by 10%?Complete appropriate testing with clearing houses to insure that denials for coding are accurately reportedStaff and train billers for the extra workloadContract re-negotiationDevelop budgetReporting ChangesReports will need to be reviewed and remediatedUpdate all affected policies and proceduresImplementation Strategy
Define areas of analysis current use of ICD-9 systems workflows Managed care contracts training needs find the gapsLimit to scope and available hours
Oversee the implementation of a comprehensive training and education planMonitor and meet project objectives within approved budget planDevelop ad hoc cross-functional teams where neededReview and modify organizational structures and processes as needed to assure a smooth conversion to ICD-10Review recommendations related to software, tools, training, processes and productivity impacts to assist with a smooth implementation of ICD-10Identify and develop strategic projects related to ICD-10
Other teams;ICD-10 systems complianceRevenue cycle redesignClinical documentation and content enhancementPhysician Education and alignmentCoder retention strategyICD-10 data strategy Do you have the right people and the right tools?Vendor management
Documentation ReviewWhat areas are affected?Do the affected areas have a plan and timeline?Concurrent use of codesFor a time period ICD-9 & ICD-10 will be usedProvide documentation for the top 30 diseasesTraining StrategyDocumentation for all audiencesTypes of training – online, lunch & learn, etc.Policies & ProceduresReview and updateAble to make decisionsEngaging physicians:Connect ICD-10 information with EMR enhancementUse less training sessionsReduce the barrier between hospitals and practice chartsFind physician championsEMR enhancementCDI design and re-designEducation events
Program / Project management Revenue cycle gap analysisAssist workgroup with process mapping and metricsCoding assessmentsSearch and selection processComputer assisted codingTranslator SystemsBusiness intelligence and program metricsCDI program review and developmentPost implementation support
Eliminate redundant processesGet the right message to the right people at the right timeStrong executive/physician-level support focused on the ICD-10 transitionProject stance: ICD-10 impacts entire organization – not just an IT projectProject management processes and principals appliedDedicated business resources will be available and assigned to this projectAvailability of workgroup leads and subject matter experts (SME), including technology and training experts