Attention Health Care Companies: Tips Toward Planning Your ICD-10 Conversion | submitted by Tom Burzinski
Recently, a number of large and complex projects have landed on the agendas of U.S. healthcare organizations like asteroids pummeling New York in a Hollywood disaster movie. One very large project that is just now showing up on the radar screens of healthcare organizations is the HIPAA mandate to convert to the ICD-10 coding classification standard by October 1, 2013.
ICD codes permeate the four major processes in a typical provider – arranging care, delivering care, accounting for care, and managing care. Because the conversion to ICD-10 will touch the majority of departments, processes, and applications within a typical healthcare organization this effort may end up making even an EHR implementation seem manageable and straightforward in comparison. To call the conversion to ICD-10 a Y2K-like project for a healthcare organization is not an overstatement.
ICD stands for International Classification of Diseases and is the standard that healthcare uses to encode diagnoses and procedures; it is one of the mandated code sets for HIPAA. The current ICD-9 codes have been in use in the US since the late 1970s. The new ICD-10 codes greatly expand the number of diagnosis and procedures — about 5 times and 50 times respectively. ICD-10 is a key tool for improving healthcare quality in that it promises more accuracy in provider and payer data exchanges, more precise statistics on business and clinical activities, and greatly improved clinical business intelligence.
Most healthcare providers are just now becoming aware of the huge amount of work and re-training involved in converting applications, processes, and workflows to ICD-10 by October 2013. Due to more immediate and competing priorities, most organizations have focused their attention and applied their resources elsewhere as we approach the end of 2010. Although October 2013 may seem far in the future, given the magnitude of the ICD-10 effort, there is, in reality, very little time left to get this effort up and running.
Healthcare companies that aren’t at least planning for ICD-10 today face severe work disruptions and delayed or outright lost payments. Although it is possible that CMS (the Centers for Medicaid and Medicare Services) may delay the conversion, no healthcare company should delay planning for this multi-year effort. Countries that have already made the switch — most with far smaller populations than the U.S. — have taken 3 or more years to complete the work. Furthermore, it is unlikely that CMS will delay ICD-10 too long. CMS and several large payers appear ready to accept ICD-10 codes by the deadline, so any organization that lags too far behind its peers is at risk.
Serious, focused, executive-level ICD-10 planning should have started already within your organization; if it hasn’t, it must start immediately. A well-planned and managed ICD-10 conversion increases the chances of a smooth, successful transition, while allowing you to receive the benefits (which can be significant) of using this more complete and detailed code set. Planning will not prevent ICD-10 from being a disruptive event for your organization requiring significant investments of time, people and money. However, planning now will prevent the ICD-10 conversion from becoming a crisis with the real prospect of negatively impacting your revenue, costs, and patient care and quality when October 2013 arrives.
The first step in planning for an ICD-10 conversion should include a complete assessment of the impact of this change on your organization. The outputs of this assessment should include: 1) an enterprise-level implementation strategy, plan, and budget; 2) an educated and aligned group of stakeholders willing to commit significant time and resources to the effort; and 3) a clear understanding of ICD-10’s risks and benefits. Depending on your organization’s size, this assessment could easily take six months or longer to do thoroughly.
In brief, an ICD-10 readiness assessment should include the follow major activities:
- Establishing a cross-functional steering committee to oversee the ICD-10 assessment, as well as long-term enterprise conversion governance. This committee should include business, clinical and information technology representatives and should be chaired by a senior member of your executive team. Because ICD-10 impacts financial performance so heavily, we recommend that the Chief Financial Officer (CFO) chair this committee. Please note that ICD-10 is not solely an IT effort; upgrading your technology and applications alone will not get ICD-10 done.
- Creating awareness of ICD-10 within your organization. This activity involves educating senior leaders, along with business, administrative, and clinical managers, and members of the medical staff on the risks, necessity, and benefits of ICD-10, and how their function or role will be impacted by this change.
- Creating a formal change management process whose goal is to minimize the "fear of change" within your organization.
- Creating a preliminary mapping of ICD-9 to ICD-10 codes for your organization.
- Assessing your organization’s readiness for ICD-10. In other words: "How big is this thing going to be and do we have the resources to get it done?" Areas to look at include:
- A review of the current IT, business and clinical staff to determine if you have both enough people, as well as the "right" people to complete an undertaking of this size.
- A review of the various IT systems in place to determine which systems need to be upgraded, replaced, or added.
- An inventory of all available documentation on the processes that use ICD-9 along with the subject matter experts who know where and how ICD-9 codes are used, and what it will take to convert to ICD-10.
- The building of high-level workflows for key ICD-9 impacted processes.
- An understanding of your organization’s capacity, including budgets and training needs, to complete ICD-10.
- An understanding of the impact that other business and technical projects or initiatives planned for your organization in the next few years have on the ICD-10 conversion, for example, mergers, new IT systems, the economy, your marketplace, anticipated legislation, etc.
- Creating a bottom up budget for ICD-10 by department and rolling these up to an enterprise-level budget based on the information obtained during the assessment steps above.
- Determining and understanding ICD-10’s impact on your partners and vendors. In other words, "What are our partners doing about ICD-10 and who will or will not be able to help us with the conversion?"
- Performing a formal and realistic ICD-10 risk-analysis.
Following the assessment, you should have some of the information and the beginnings of the ICD-10 governance structure you need to develop an overall technical, business, and organizational ICD-10 implantation strategy and plan, including the budgets and timelines to get you to October 2013. You can then review these plans and budgets with senior management and other interested parties.
This article only scratches the surface of the challenges facing healthcare organizations as they work to convert to ICD-10: your primary take away here should be a commitment to begin planning today for your ICD-10 conversion.
Tom Burzinski is with Bridge Health Partners.
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