ICD-10: Will you be ready?
Healthcare Finance News Managing Editor René Letourneau spoke recently with Rosemary Sheehan, vice president of revenue cycle operations at Boston-area Partners HealthCare system about her organization’s ICD-10 preparedness efforts:
How is Partners HealthCare preparing for ICD-10?
Partners established a structure with executive leadership to help to guide the work that needs to be done. We have developed a central project plan and inventoried every system that needs to be remediated to assure accurate implementation of ICD-10, from clinical to billing to research databases.
We have begun to have a conversation with physician leadership and the initial feedback from physicians is that there are benefits to ICD-10.
It’s going to require a specialty-specific review. We’ll be going specialty by specialty. We will have to be very clear with physicians about the changes they will have to make to their documentation and charge capture to ensure we get the full benefit of ICD-10.
Is there resistance among physicians and staff?
There has not been any push back, but I think it’s too early. I also think articles, like the one in the Wall Street Journal recently, that point out absurd codes in ICD-10 hurt the dialogue. When physicians read that they don’t see the benefits to clinical care. We have to start the dialogue with things that are meaningful to physicians so they really understand it can have a good impact on quality of care and data that we can’t get today with ICD-9.
What are the biggest challenges?
One is helping physicians to understand the new codes and how they impact the overall health status of patients. A lot of codes in ICD-9 today don’t provide enough data. For example, one of the things that came up with the ICD-10 discussion is that there are new codes to highlight when patients are not responding to treatment because they aren’t taking their medication. There are no ICD-9 codes to report that. With ICD-10, we will be able to capture it. We will be able to determine how much is due to lack of patient compliance.
What tools are you considering implementing?
We’re exploring computer-assisted coding software and are currently reviewing several vendors. If we utilize natural language processing, we should be able to achieve some efficiencies and not be short staffed when the conversion occurs. We’re trying to remove paper from the system. Right now, we use a lot of paper to capture what the physician did and why. EMR will be connected to the charge codes to capture information in an electronic format.
Is this keeping you up at night?
Definitely. There’s no question. This is a huge amount of change and it impacts everything the hospitals and physicians do. This is impacting all of our operations.
The way to deal with that is to do proper planning. We have set forth to develop a plan that can be executed centrally and jointly. We are doing a lot of work with our vendors, asking if they are ready and what they are doing to prepare. We’re trying to learn from other countries that have already implemented ICD-10.
What do you expect to see as a result of ICD-10 implementation?
What we’re unsure about is how this will change the editing and denial efforts from payers. Today, we have tools to manage code edits, and we know what it means in terms of denials. There’s going to be a lot of dialogue with payers in the local market and also with Medicare, and we’re not sure how that will play out.
Like any major change, there will be some challenges. If we can have a good, positive dialogue with payers, then we can prepare for the change. If we don’t, it will be challenging. We just need for there to be a partnership between providers and payers so we can all do this well.
