No Guidance Given: Getting to ICD-10 May Mean More of Your Own Effort

Following the recent delay of ICD-10 to October 2015 and the continual talk from those of us in healthcare about how the time can be best spent until then, there seems few guideposts and signs along the way for managing the process. ICD-10 is more than a delay, more than a few conversations about a variety of codes that depict a variety of somewhat outlandish diagnoses.

ICD-10 is a massive undertaking as much as it is a conversation starter. By itself, it represents new budget lines, more work for limited resources and affects most areas of the care system dramatically, especially the lines of business responsible for bringing in funds through paid claims. With all of this and more, there seems to be very little guidance about how health systems should be managing the process.

The delay, which has been discussed in detail for months, affects two camps – those who are prepared and those that delayed and are relieved by its procrastination. Of course, those had not prepared are currently loving this latest development, but for those who have focused on innovation, bringing in support and ratcheting up dollars to support the effort – they probably feel alone.

The delay affects several primary areas within a hospital, of course, according to IT analytics firm Jvion. Like them, we believe, in most cases, that the codes that are going to be used on a daily basis are likely to be the same from day to day. In fact, organizations are likely to become familiar once again with the codes that run their daily lives. The outlying codes, however, may take a good portion of office administrator’s time, but the number of unfamiliar codes that need managing should be small enough for most health systems to manage effectively.

“Addressing challenges is the next phase of ICD-10 journey,” writes Todd Schlesinger, author of the paper “Practicality in Uncertainty: What it really takes to navigate the ICD-10 delay.”

“The first step down that path is to reduce the size of the problem. It is imperative that providers right-size each aspect of the conversion to maintain a trajectory that will drive compliance while mitigating risk.”

There are numerous ways to reduce the risks of the ICD-10 delay. Here are a few high-level approaches:

Establish clinician engagement efforts

One of the most important factors will be open and ongoing communication with providers and caregivers. The communication must be targeted and tailored to the specific audience and must show how what they do matters. Like in most other implementations, clinicians must understand their role in the plan, why it matters and how they can help carry the project to a successful conclusion. How employee fit into the ICD-10 plan is important and they must understand exactly how this is so. “Communication plans, change management activities and goal setting should all align to the type and degree of risk associated with each person,” Schlesinger writes.

Control the spend

Not everyone requires the same amount of training, just like not every requires the same number of resources to manage a project. Even small changes can seem overwhelming, though, and that’s likely the problem with ICD-10. In many cases it’s likely that a minimal amount of education and training will go a long way as long as it’s ongoing throughout the implementation. Where possible, scale back the education that you provide to only those who need to receive it. The implementation plan should take into account approaches for helping keeping coder’s skills fresh and updated at the highest skill level, but also should provide a contingency in regard to training employees as appropriate. “Dual coding, ongoing classroom and on-the-job training and a specialized train-the-trainer program that emphasizes the ICD-10 expertise of key individuals should work. For everyone else, ICD-10 training may be as simple as an online refresher course or coding guide. The point is that training does not have to be completely redone because of the delay. Yes, providers will have to adjust, but plans can be prioritized and training curricula can be customized based on risk and impact,” Schlesinger notes.

Engage support as needed

In addition to controlling the transition spend, organizations may find relief in bringing in support to manage the implementation of ICD-10, the training of staff and managing the project without needing to involve your entire staff in the minutia of the entire project. Third-party, outside assistance is likely one of the most efficient ways in which a hospital can move forward with ICD-10 without disrupting their daily operations. In fact, this is likely one of the reason so many health systems have not moved forward with their planning and preparation. Even though doing so mean an upfront resource allocation, it will likely lead to a reduction in strain to organization’s staff responsibilities, who in turn will be able to focus on current their priorities and tasks and receive elbow-to-elbow support during the roll out.

The ICD-10 delay is changing the business of healthcare, no doubt, and there’s evidence to suggest that many folks would rather the challenge come and go and we, as a sector, move on with other issues. Again, there are winners and losers in this game, but when the latest deadline is approached, everyone will be forced to be in the same situation despite how prepared they are now or where they will be next year. Each organization will need to determine what ICD-10 means to their organization and how they are going to reach their goals in this regard. And, even with the few steps of guidance listed here, there is a great deal more guidance needed.

It will come, perhaps even here. Stay tuned; there’s a great deal more to come in the next year.

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