Published in the May 2014 issue of Today’s Hospitalist
NOBODY SAW THAT COMING! Just over a month ago, Congress passed a bill that brought a year and a half of efforts on the part of most health systems to a pretty abrupt stop.
The bill in question mandated putting off the implementation of ICD-10 until at least Oct. 1, 2015. As the ICD-10 physician advisor for Via Christi Health in Kansas, that certainly got my attention. I’ve read estimates that this delay is costing the health care industry between $1 billion and $6 billion.
Like most hospitals, ours had already trained a cadre of coders and paid vendors for electronic training modules.
Good documentation is ICD neutral.
Many hospitals had already paid to upgrade their IT systems. And many systems had put in the time to map their ICD-9 data to ICD-10 codes, coming up with physician guidelines for how to document the top diagnoses hospital-wide that make up the highest volumes and have the biggest impact on reimbursement.
Now, we’re all facing questions that we need to answer. Should hospitals or clinics pay vendors or buy the software that has already been ordered for a go-live that’s been put off another year? Or should they take all the resources they’ve gathered and simply put them on hold for two months, or six or eight?
Hopefully, we won’t lose all the ICD-10 momentum “and that’s particularly true for hospitalists. The new billing and coding system will result in much richer data. For hospitalists, that means a much more detailed snapshot of the quality work that we do and the severity of illnesses, complications and comorbidities that we treat.
Here’s my spin on this latest delay: In the hospital, good documentation is ICD neutral. We don’t need to wait for the launch of ICD-10 “and the Centers for Medicare and Medicaid Services (CMS) still hasn’t clarified exactly when that will be “to become experts in documentation.
An upgrade for hospitalists
Obviously, ICD-10 is a contentious issue throughout the medical community. While implementation seemed to be on schedule in big hospitals and health systems, that may not have been the case for rural hospitals and outpatient practices.
For hospitalists, ICD-10 may not have meant the type of administrative burden that outpatient practices face; we don’t have to hire coders, train them or worry about their performance. And as a workforce that’s more aligned with the facilities where we work, many of us continue to see ICD10 as an opportunity for us to differentiate ourselves in the hospital.
Richer, more specific documentation is the key to establishing our value, reporting quality more accurately, raising our own profile and delivering a bigger return on investment. We will have to invest some time on the ICD-10 learning curve. But ICD-10 is a much better classification system than its predecessor, and the payoff for acquiring that expertise is an upgrade of our own. It will make us more valuable members of the medical staff.
Take advantage of the delay
Where do we go from here? Given this latest delay, some commentators have wondered if we’ll ever switch to ICD-10, or if we’ll just keep on postponing it until ICD-11 is released and ready to go.
That wouldn’t be my prediction. The World Health Organization won’t release ICD-11 until 2017, which means that the American version ” each country has to accept that code and make it its own “wouldn’t be ready until 2020 or 2021. I’m not sure that the CMS or all the many vendors invested in this want to wait that long to implement a new system.
Plus, that switch would be just as labor- and resource-intensive as this one is proving to be, and the CMS has already invested quite a bit in ICD-10. It also may be too difficult for us to jump an entire edition altogether.
Instead, I would urge doctors and hospitals to take advantage of this delay and make sure our time and money don’t go to waste. If hospitals or practices can still do testing with insurance companies, they should do so.
If you’ve already signed up for technology testing and vendors are still available, you should continue that testing as well. As for doctors, I see this as another year for us to get up to speed with ICD-10-ready documentation penalty-free.
When it comes to hospital documentation, whatever improvements we need for ICD-10 still hold true for ICD-9. Better documentation “more specific and complete “is better even for ICD-9.
Striking a balance
Most health systems are now trying to figure out how to balance not spending too much time or money on readiness with not relaxing to the point that they won’t be in good shape for 2015.
Hospital coders may still want to file dual coding on some active cases even before ICD-10 goes live, just to be able to check their ICD-10 accuracy without any financial penalty. And hospitals may want to get back on track with ICD-10 training, even this year.
I still think that becoming documentation experts is a real opportunity for hospitalists, one that will have a big impact on reimbursement in an accountable care environment. Hospitalists need to adopt accurate documentation as standard practice, and that’s the big message of ICD-10 “whenever it arrives.
Sam Antonios, MD, is a hospitalist at Via Christi St. Francis Hospital in Wichita, Kan., and the ICD-10 physician advisor for Via Christi Health.