February 18, 2009
Note to HWYTK Readers: HFMA is pleased to announce its new Healthcare Financial Pulse project. Sponsored by McKesson and RelayHealth, Healthcare Financial Pulse will track in real time the challenges, opportunities, and emerging trends that are affecting the financial status and future shape of the healthcare industry, and will provide tools, information, and successful practices to help hospitals succeed in this challenging environment. Initial research providing baseline data on the financial health of U.S. hospitals and health systems is currently available on the project web site. The project will also feature a series of audio webcasts. The first webcast, free to HFMA members, will be on March 10, 2009, from 2:00 to 3:45 p.m. Central time. Register today.
Implementing ICD-10
Last month, the Department of Health & Human Services issued a final rule on adoption of the new ICD-10 code set, setting a compliance deadline of Oct. 1, 2013. Introduced by the World Health Organization in the 1990s, ICD-10 is now on track to become a reality for U.S. healthcare providers within the next few years.
As healthcare providers begin plans for implementing the new classification system, they can look to Canada for lessons learned in its own implementation process, which was completed in 2006. The February 2009 issue of HFMA's Revenue Cycle Strategist newsletter offers insights into what we can expect in the United States based on the Canadian experience.
Leadership and Training
It is essential that each organization have a project leader for implementation of the new ICD-10 code set. Ideally, this individual will have a background in health information management and be familiar with how the new classification system works. This individual will take the lead in all aspects of ICD-10 implementation.
A key function of the team leader is overseeing the training of individuals new to the classification system. Staff who will be most involved in implementation should be trained early, so they can help with the selection and upgrading of current systems, manage the execution of new system testing, and oversee the training of other staff.
One important lesson from Canada was not to skimp on training. Canada recommended a five-day self-learning package combined with a two-day in-person training session. This proved insufficient for coders who fully use the classification system, including coders within acute care facilities. Canada also found that staff with the most training were quickest to recover from lost productivity resulting from implementation of the new system.
A session on "Migrating to ICD-10: Implications for Reimbursement and Quality," will be offered at this year's ANI: The Healthcare Finance Conference, June 14-17, in Seattle, Washington. Learn more.
Productivity Losses and Costs
At some Canadian hospitals, productivity fell by 50 percent during the first three to six months after implementation of ICD-10. Although productivity rebounded within a year, acute care facilities never returned to their pre-ICD-10 productivity levels. Because of the much higher degree of specificity in the ICD-10 codes, coders must spend more time looking for detailed information within patient records. In the Canadian equivalent of ambulatory care settings, which rely more on predefined coding lists, the impact on productivity was much reduced.
Information system changes can also have a big impact on the cost of implementation. New software or upgrades to existing programs will likely be required, and this software may also require new hardware to support it. For example, Canada found that some facilities had to provide larger computer monitors for the coding staff to accommodate coding books that were now available only in an electronic format. Canadian facilities also faced one-time fees imposed by vendors to upgrade their systems to ICD-10.
A Revenue Cycle Strategist web exclusive features comments by Kerry Johnson, author of the article on the Canadian ICD-10 experience, on preparing for ICD-10 in the current economy (free to Revenue Cycle Strategist subscribers, or subscribe today).
Strategic Planning
Although there will be significant work and cost involved in implementing the ICD-10 code sets, the enhanced data resulting from the new classification system could give a competitive edge in terms of quality measurement reporting, value-based purchasing, and patient safety to hospitals and health systems that are strategic about implementation. More information on the challenges and opportunities of ICD-10 implementation is provided in HFMA's ICD-10: Capturing the Complexities of Health Care.