After delays in 2013 and 2014, the Oct. 1, 2015, deadline that marked the transition to ICD-10 code sets passed without major incident. But experts agree hospitals still need to keep a close eye on staffing and revenue trends to minimize disruptions.
“The industry has been pretty quiet,” says Cindy Nichols, senior vice president of health information management of Parallon’s Revenue Cycle Services. “Those who adequately prepared ahead of time are managing the transition well right now.”
However, Nichols dismisses comparisons drawn to Y2K, when fears over a global computing meltdown on Jan. 1, 2000, turned out to be completely overblown.
“It’s nothing like Y2K,” she says. “It’s a much bigger deal, and there’s still a lot of work going on. We won’t be anywhere close to marking ICD-10 a victory until sometime in 2016 and possibly beyond.”
Focusing on Productivity
ICD-10 increases the number of codes in use from 18,000 to 155,000. Focusing on the most commonly used codes can help prevent staff from being overwhelmed, but coder productivity is still a huge concern as hospitals monitor the impact of the transition.
“Has there been a productivity hit? Absolutely,” Nichols says. “For inpatient charts, it’s as high as 50 to 60 percent.”
The main issue is that, for now, there’s no such thing as an ICD-10 expert. Nichols says hospitals that staffed up appropriately probably aren’t missing a beat. Those that didn’t are likely facing problems.
“There are hospitals out there that are hurting,” she says. “All you have to do is an Internet search to see the sign-on bonuses being offered. A lot of organizations are throwing serious cash at potential hires to get them in the door, and that tells you all can’t be perfect with the ICD-10 transition.”
Nichols says hospitals must focus on improving productivity without sacrificing accuracy. That means actively managing coding staff, as well as working with clinicians to ensure there’s accurate documentation in the chart to support the increased code specificity. Leaders should also closely watch coding staff turnover rates, being proactive about lining up replacements before there’s a critical need.
Even with these measures, experts agree the transition will likely bring a permanent reduction in coder productivity.
“We don’t think productivity rates will ever get back to where they were,” Nichols says. “At some point in 2016, we think we’ll achieve a new norm that’s slower than where we were with ICD-9.”
Nichols predicts continued improvement will ultimately allow hospitals to rely less on contract coders and additional staff. She also points out that the coder shortage will likely persist.
“Will the pricing of contract coding, the bonuses and the whole compensation game settle down, or will there be a new norm? The jury’s still out on that,” she says.
Understanding Revenue Impacts
Beyond staffing costs, healthcare leaders have been concerned about the potential revenue impact of ICD-10. Many experts predicted significant spikes in claim denials, a fear that hasn’t materialized so far.
“Cash is coming in the door and claims are being paid,” Nichols says. “We’re definitely seeing some DRG [diagnosis-related group] shifts—some we predicted, some we didn’t.” She adds that it’s too soon to tell what the short-term, intermediate and long-term ramifications will be.
Chad Wasserman, Parallon’s Revenue Cycle Services’ chief information officer, says the next few months are important for watching how payers respond to the change. According to Wasserman, leveraging advanced data science can help hospitals stay ahead of major revenue shifts.
“It will be interesting to track how payers process claims and map codes, and whether that’s consistent across geographies and different payers,” he says. Proactive management of key performance indicators (KPIs) such as claim denials and case mix index (CMI) can provide valuable insights into coding quality and DRG shifts.
“We’re still in the first stages, but there’s good intelligence to be gained,” Wasserman says. “We may be able to see earlier signals of what’s occurring—good or bad—and take action based on that intelligence.”
That could mean renegotiating contracts with payers, adjusting expected reimbursement models, adding more staff or even changing business systems.
“Predictive analytics let you know when you’re walking into a problem so you can head it off,” Wasserman says.
And while insurers and clearinghouses alike have reported minimal difficulties thus far, Parallon experts aren’t willing to declare victory until trends in payer behavior become clearer.
Tracking ICD-10 Impacts
As things continue to settle during the ICD-10 transition, hospitals must continue to watch coder productivity and payments in order to stay ahead of any potential revenue impacts. To do that:
• Manage your coding staff. It’s essential to closely track turnover rates and get proactive about hiring before problems occur. It’s also crucial to remember that accuracy is just as important as productivity.
• Support your clinicians. Identify super-users who can help colleagues on the job. Medical scribes can also help with real-time transcription of medical records.
• Monitor your KPIs. Revenue cycle teams should keep a close eye on claim denials or rejections, as well as the CMI and any DRG shifts. Predictive analytics and business intelligence can be used to drive actionable insights and keep hospitals on the right track.
The Provider Perspective
Early reports revealed some complaints from providers, including a few technology glitches and trouble getting accurate information on coding requirements. Aside from those initial bumps, however, problems have been relatively minor and few. Aron Wahrman, M.D., a plastic surgeon at Temple University School of Medicine and a HealthTrust Physician Advisor, believes the electronic medical record (EMR) has largely shielded providers during the transition.
“This is one of EMR’s benefits,” he says. “A lot of the conversion has been built into the system. When I drop down the descriptor, the proper ICD-10 code comes up.”
The updated codes now allow clinicians to capture important specifics like whether it’s an initial or follow-up visit, or whether a patient’s right or left hand is injured. This increased precision has the potential to deliver more robust data to track treatment and outcomes from health records.
“The transition reflects the fact that so much of healthcare is going to be driven by data,” Wahrman says. “We’re trying to adopt a language that’s much more accurate in painting a clinical portrait of what’s going on with a patient.”
He says the change was a long time coming, pointing out that ICD-10 has been available since the early 1990s and widely used in other countries since 1994. Overall, the increased refinement and code specificity was necessary as EMRs and meaningful use became more important.
“It’s really about making sure everybody’s on the same page, using the same language to make sure the flow of information—as well as the revenue to take care of patients—is there.”
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