Op-Ed: The Boy Who Cried ICD-10

Op-Ed The Boy Who Cried ICD-10The following is a guest contributed post from Bonnie Cassidy, senior director of health information management (HIM) innovation for Nuance.

I used to tell my daughter the scary story that my dad used to tell my family about the “Boy Who Cried Wolf.”  It is the story of a young man who liked to stir up drama with false rumors about a hungry wolf, so much so that when the townspeople were in actual danger, they didn’t believe him.  While most of the health information technology (HIT) world was at the HIMSS15 convention last week, the Senate unanimously voted, 92-8, to repeal the sustainable growth rate (SGR) formula that adjusts Medicare payments to physicians and effectively put an end to a flawed formula for Medicare payments, as well as any ICD-10 implementation delays.  For more than 20 years, and with three official delays, the industry has been crying wolf, but it now appears that the transition to ICD-10 will indeed occur on October 1, 2015.

For those of us who have been through the series of false alarms, this almost seems unbelievable. Like the townsfolk in the story, we’ve become victims of alert-fatigue. Of course, we must be vigilant and continue to monitor all legislation, however, with the SGR repeal complete, AHIMA staff and ICD-10 proponents will now turn their attention to the upcoming series of appropriations bills about to make their way through Congress. AHIMA’s advocacy staff has identified the sometimes contentious appropriations process as the next place an ICD-10 implementation delay could be attempted. The first of 12 appropriations bills will move to committee this week. Congress has until the end of the fiscal year, September 30, to pass the bills and fund various government programs and entities.

That being said, for the first time in many years, the outlook is bright for ICD-10 compliance on October 1, 2015, which is exciting news for this country.

Creating better care through better documentation

Having been through so many start-stop ICD-10 implementation plans, we need to make sure we stay focused and keep our eye on the prize: better patient care through accurate documentation. The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding, and the documentation of the patient’s story is critical to this.  Not getting a full picture of the patient’s condition not only can lead to delayed diagnosis or misdiagnosis, and negatively impact the quality of care.

ICD-10 is an opportunity for physicians, hospitals, and other providers to exchange information with health plans to describe a patient’s condition and the services that were provided to treat those conditions.  As we shift from a volume-based payment system, i.e., how many patients go through the door and how many tests are issued, to a value-based system, one that measures patient outcomes and the level of quality care as evidenced by such things as hospital-acquired infections (HAI) and readmission rates, accurate clinical documentation and medical coding play an even more vital role in ensuring organizations are appropriately reimbursed for the care they are providing.

Doctors on documenting

It’s now time to dust off your ICD-10 implementation framework and begin rolling out your physician education plan.  At just about six months out, introducing the documentation specificity changes to clinicians incrementally will help create familiarity while giving them time to adjust to the new rubric.

I’d be remiss if I didn’t mention that ICD-10, while a definite change for the HIM profession, will not impact physicians in the same way.  Those of us in the field know that clinicians have very analytical and precise minds, but they don’t always document all the details.  ICD-10 isn’t about getting physicians to learn anything new, it is about reminding them to document those specifics so they can be properly coded.  This level of detail is an important piece of creating a robust picture of the patient’s health and is needed to ensure high quality of care is provided across the healthcare continuum.

The key to a successful October is staying level-headed and sticking to your implementation plan.  We’ve been through the dress rehearsal (many times), now we’re ready to go prime-time. Your teams have been working toward this goal, they are ready.  This coding story can have a fairy tale ending— it is just a matter of rolling out your plan as intended.

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