• Turning ICD-10 Into a Clinical Priority

    Feb 20, 2014

    Kari Cornicelli

    Kari Cornicelli is leading an initiative to educate Sharp Healthcare’s physicians to document with the specificity required under ICD-10—while also capturing the data needed to identify opportunities for improving quality and reducing costs.

    Throughout her career, VP/CFO Kari Cornicelli, Sharp Grossmont Hospital, La Mesa, Calif., has been a champion for improving collaboration between finance and clinicians. “The finance team’s role is not to just produce and distribute data. It's also important that we articulate what the data means and help end users identify opportunities within the data,” says Cornicelli, who is also HFMA’s chair-elect.   

    Cornicelli’s latest initiative involves spearheading the ICD-10 transition for the entire Sharp Healthcare system. A successful ICD-10 deployment is obviously key to accurate reimbursement. But Sharp Healthcare, which is a Medicare Pioneer ACO, has also embraced the major coding change as an opportunity to enhance the capture of quality-related data, including Medicare core measures.

    Providing Clinical Intelligence 

    In addition to the ICD-10 project, Sharp is rolling out clinical intelligence software that can merge and analyze ICD-10 codes, quality data, and cost information from Sharp’s clinical and financial systems. This will prove vital in giving the health system a road map to potential opportunities for improving quality and reducing costs, including improvements under population health management. Sharp-affiliated physicians will be able to benchmark their performance against other physicians, allowing them to analyze variances in practice and improve their profiles under Medicare’s Value-Based Purchasing Program, which rolls out for physicians in 2015.  

    “Everyone thinks of ICD-10 as a financial change, but we are turning it into a clinical process improvement project,” says Cornicelli. 

    Supplying the Right Tools

    “Clinical documentation is the foundation of ICD-10,” says Cornicelli. “We are teaching our physicians how to document with the specificity required by the new ICD-10 codes so we can capture accurate information on the care delivered to patients,” says Cornicelli. 

    To assist in that effort, Sharp Healthcare has dedicated clinical documentation specialists who review physicians’ documentation and identify areas for improvement. As part of the ICD-10 project, physicians will also have access to computer-based instruction, pocket cards with documentation tips, and phone apps, as well as the traditional classes and discussions that explain the new ICD-10 documentation requirements.

    Sharp’s physician and clinical nurse informaticists?clinicians who specialize in developing the electronic health record?are refining physician documentation templates to reflect the requirements of the new ICD-10 codes. The templates will prompt physicians to provide documentation that reflects ICD-10 specificity, verify medical necessity, and supply quality information, such as venous thromboembolism (VTE) prophylaxis and code status. Sharp also plans to include voice-recognition capability to ease the amount of time physicians spend typing patient care information into the templates.

    “We are focused on the purpose of the templates, what information needs to be included in those templates, and how to provide physicians with tools that allow simplified documentation that captures the more specific ICD-10 language in their documentation,” says Cornicelli.

    Sharp has already started to see results from its documentation efforts, with Sharp facilities reporting improvements in severity of illness scores between 0.5 to 16 percent. “We are now starting to see improved documentation and more thorough specificity for the care that is provided. When doctors are in a hurry, they often don't take the time to thoroughly document. Physicians are taking care of patients who are very sick, but the severity of illness hasn't been captured because of the lack of specificity recorded in the chart. They are providing excellent care, but if it’s not recorded in the chart, it’s as if it didn’t happen.”  

    Capturing Opportunities 

    Sharp’s ICD-10 conversion is more than a system or coding change. Cornicelli’s lead role in the conversion is developing new lines of communication between finance and clinical staff. 

    “For me personally and professionally, it’s been rewarding to work with the interdisciplinary team on the ICD-10 conversion project. Team members from across the entire Sharp system have worked on the various projects, and it has been exciting to see everyone work together to improve the organization. It has given me an opportunity to work with physicians across the health system, and it’s been rewarding to see them embrace these new documentation challenges and successfully work with the new ICD-10 requirements,” says Cornicelli. 

    Kari S. Cornicelli, FHFMA, CPA, is vice president, CFO, Sharp Grossmont Hospital, La Mesa, Calif., and HFMA’s 2013-2014 chair-elect.