Beacon Partners / BridgeFront ICD-10 Webinar: Building the Bridge as You Walk on It

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

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• 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

Agenda

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Current Status of ICD-10 Transition

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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

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

ICD-10 Revenue Cycle Impacts

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Key Transition Strategies

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Heading – Ariel 40ICD-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

Organizational Strategies and Goals

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Define the work to be accomplished

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Heading – Ariel 40Quick Look: ICD-10 Gap Analysis

• ICD-10 – Not Just an IT ProjectA Codes live everywhere in the organization A The gap analysis is designed to understand where codes are

currently utilized in the organization

• Gap Analysis Designed to:A Determine areas and roles where codes are utilizedA Determine processes where codes are utilizedA Complete software inventory, vendor query process, and

impact analysisA Complete outline of training and communications planA Understand financial impact of the transition

• Challenges and Opportunities:A Communication of practice-wide impactA Role-based workforce educationA Updating processes and softwareA Assuring revenue neutralityA Determination of financial impact

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• Processes and departmentsA Revenue CycleA QualityA EHR toolsA Clinical Documentation/Chart auditsA Non-IT Project managementA IT

• Entities that can be out of scopeA Retail pharmacyA Wellness Centers

Define the Scope

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Heading – Ariel 40Technology Assessment and Reporting

EXTERNAL REPORTING ICD-10 HIGH-LEVEL IMPACT DASHBOARD

DepartmentICD-10 Impacted External Reports

Yes Unknown Indirect NoneCardiac / Stroke 1 2 0 3Diabetes Education 0 0 0 1Family Birthing Center 2 0 0 1HIM 1 0 0 3Home Health 1 0 0 0IT 1 0 0 0Joint Program 1 0 0 0Oncology Program 1 0 0 0Patient Financial Services 2 0 0 0Quality 3 0 1 4Radiology 1 0 0 0Trauma 1 0 0 0

TOTAL 15 2 1 12

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Insert Revenue Cycle Optimization graphic

Financial Planning - Revenue Cycle Optimization

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Heading – Ariel 40Key Financial Dashboard Metrics

Metric InformationAccounts 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

A HIM/ CodingA Patient Financial Services

• Training StrategyA Documentation for all audiencesA Types of training – online, lunch & learn, etc.

• Train the policy and procedure changes

Training and Education

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Heading – Ariel 40Organizational Capability

Current State Roadmap to ICD-10Executive 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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Assumptions and Constraints

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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

Project Assumptions and Constraints

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95; 78%

27; 22%

Do you know what ICD-10 is?

YesNo

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

YesNo

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Creating your organizational work structure

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• Steering Committee and WorkgroupsA Plan the strategyA Create overall project planA ICD-10 Steering Committee

• Multi-disciplinary• Able to make decisions• Fluid

• WorkgroupsA What areas are affected?A Identify current teams and committees A Do the affected areas have a plan and timeline?

Organizational Structure

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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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Heading – Ariel 40Project Management Structure

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Heading – Ariel 40Project Management Structure

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• Focus on patient care, documentation, and coding

• Promote and expand your clinical documentation initiativesA Use training, software, and Clinical Documentation Specialists

A Automate prompts and templates

• Educate your providers

• Lay your metrics as a base, and then monitor for:A Improved patient assessment

A Improved clinical documentation

A Improved coding

A Improved information

A Improved outcomes and improved business

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

Leverage Existing Infrastructure

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Effective Use of Your Partners

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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

A Revenue cycle managementA Clinical documentationA IT – system specific

• Identifying each focus area and assessing

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

A Keep senior management informed to remove roadblocksA Work for senior management support and buy-in

• Leverage everything you can – people, processes, and technology

• Think outside of the box

Take-Aways

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419 days left!

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Questions?

Thank YouFor more information

please contact:

[email protected]

1.800.4BEACON │ BeaconPartners.com

BOSTON · CLEVELAND · SAN FRANCISCO · TORONTO32

For more information please contact:

Christine [email protected]

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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.

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Christine Kalish, MBA, CMPE

Christine KalishNational 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..