Now that the healthcare industry has an extra year to implement ICD-10, providers should take advantage of that time to properly prepare for implementation in Oct. 2014, coding professionals say.
"The delay was hoped for and those counting on it got lucky," said Shane Pilcher, vice president with Pittsburgh-based Stoltenberg Consulting. "But the 2014 date is set in stone, so the luck will not continue."
Little by little, business dynamics in the industry are incrementally changing so that ICD-10 will be a logical step forward once transition time arrives, Pilcher says. As providers continue to focus on improving their IT capabilities for electronic health records, interoperability and forging accountable care organizations, the added dimensions of ICD-10 should contribute significantly toward creating more details in the care-giving process.
"Ultimately it will help with analytics," Pilcher said. "The industry is creating a big data environment and turning it into business intelligence providers can use to identify trends and community health tracking. Expanding the code base will help with that."
Even so, the payoff comes at great effort and expense, Pilcher concedes.
"The list of negatives far exceeds the positives, with decreased efficiencies after implementation, loss of personnel and the added cost and training associated with this complex new coding system," he said.
While providers should feel a sense of urgency in preparing for ICD-10, the yearlong reprieve can be seen as a cushion that allows providers to approach the issue judiciously, says Deb Neville, director of revenue cycle coding and compliance for Philadelphia-based Elsevier.
"Those hospitals that went forward expecting a 2013 start date may now have the luxury of slowing down a little bit," she said. "They can be a little more thoughtful about incorporating it into other initiatives."
Given the scope of ICD-10 conversion, large hospital systems are understandably ahead of the pack. Yet medium and small hospitals must also convert to ICD-10 and are finding the process more challenging, Neville said.
"They don't have the resources and it is often overwhelming for them," she said. "So they are looking at alternatives like consortiums and online education because it is accessible 24/7."
Boosting analytics
Small and medium hospitals can find assistance in getting on track with the ICD-10 transition, however, as vendors such as Plano, Texas-based RemitDATA offer revenue cycle tools to help gauge their financial performance. The key, says COO Brian Fugere, is comparative analytics that allow providers to benchmark their results against their peers.
"What we're finding is that analytics is becoming more and more important as the market evolves," he said. "Healthcare market pressures are forcing more attention on performance based on analytics and that is where we feel we occupy a great spot in helping providers on the business side with the most efficient delivery possible. Peer-to-peer comparison allows for a thorough review of best practices."
Though Fugere singles out small and medium-sized hospitals as needing the most help, he contends that the company's "provider universe is pretty diverse, from small to large and everything in-between." He recognizes that larger systems are typically better prepared and says the yearlong implementation delay has benefitted smaller organizations more.
"The biggest sigh of relief has come from the smallest providers," he said. "But now it is time for vendors to start providing a lot of support and education as things get closer. It is up to the vendor community to help providers get ready for the switch. We've taken a breather and now it is time to get to work."
Exodus coming?
Ever since the ICD-10 plan was forged, there have been rumblings within the industry that the current crop of coders would rather quit than re-learn everything all over again. This belief has persisted over the past couple of years and has led providers to wonder if they will see mass defections just when they need their coders most.
But how real a scenario is it? Neville believes an element of truth exists behind it, but adds that it probably won't be as severe as originally thought.
"Some coders might think they are too old to change their ways, while others will see it as a challenge to increase their knowledge base," she said. "I think a lot depends on how hospitals approach this. If they engage their more experienced staff and get buy-in for training and mentoring of other staff members, utilize critical thinking and improve respect for the profession, they have a better chance of retaining their staff."
At Methodist Health in Memphis, the coding staff of 38 analysts is currently stable and there are no real signs of any experienced people jumping ship, says Donna Hunt, director of corporate coding.
"There have been a couple retirements, but that's about it," she said.
It could be because Methodist, which operates seven hospitals in the greater Memphis area, has been proactive in getting ahead of the curve with ICD-10 training. Working with Green Bay, Wis.-based IOD, the staff is already practicing the new format for diagnosis and procedure codes with thousands of records.
"There is a lot of specificity with these new codes, so we knew they would need a lot of training in terminology," she said. "After all the training we've done with IOD, I feel better that they are being prepared. I now feel good about October 2014. We are using the extra year to put systems in place instead of winging it."