Despina Kayichian, MD June 19, 2015

Transcription

1 Despina Kayichian, MD June 19, 2015

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3 CHC is A Different Beast Hospital/Medical Group Community Health Centers Clinical Documentation Specialists (CDS) for Medicare pts, concurrent chart review No CDS Coders with queries to physicians before a bill is dropped Severity of illness vital to reimbursements; Case Mix Index (CMI); Hierarchical Condition Categories (HCC) A strong investment in infrastructure supporting physicians documentation No coders Severity of illness is starting to gain importance but still not the main determinant in reimbursement Very weak infrastructure supporting the physicians The major work for ICD-10 hinges around provider education No current feedback; financial risk is high

4 ICD-10 Resources Priority Management Group (PMG) through CPCA CMS Road to 10 webpage

5 Some ICD-10 Fun Facts 14,000 codes 69,000 codes Greater than 40% of new codes are related to laterality 50% of new codes related to musculoskeletal disease Mapping is not recommended for providers documentation and coding

6 Some ICD-10 Fun Facts Content is huge so we need to focus of some general documentation principles and build from there: Tobacco use code needed with certain conditions Insulin use is not coded in type 1 DM Only 1 code for immunizations CPT codes are not changed with ICD-10 (relevant for dental services) Social determinants of health are captured with ICD-10

7 Our journey at a glance 1. Contract 1st week of December 14 pre-planning 2. ICD-10 Team formed in January 3. Communication Plan with organization 4. ICD-10 Timeline 5. Discovery Phase 6. Impact Analysis 7. Action Plan 8. Education Plan 9. Budget 10. Testing 11. Post Implementation Audits and Monitoring

8 ICD-10 Planning Choose members based on areas most impacted? ICD-10 implementation has a lot of similarities to EMR implementation but less intense Change Management team meetings held weekly Choose Project Leader Choose Project Manager We made ICD-10 an organizational priority

9 VFC ICD-10 Team Members CMIO IT/Applications Manager Nursing manager COO EMR Trainer Supervisor Coordinators supervisor Front desk and call center supervisor Billing supervisor/manager CMO (project lead)

10 Resources used along the way PMG, Priority Management Group through CPCA CMS Road to 10 webpage Dr. Margarita Loeza s brain and experience

11 Communication Plan 1. Internal Board meetings ed VFC everyone CMS introductory video ( ICD-10 update at monthly Large Management meetings Updates at site meetings Weekly slides sets for education to providers ICD-10 quiz at every monthly providers meeting We chose not to conduct a readiness survey 2. External Vendors: NextGen Payers/Health Plans MedPoint Management Registries

12 VFC ICD-10 Timeline

13 Organizational Impact Analysis We looked at every department that currently uses ICD-9 codes in their workflow We gathered every form that each department uses. Every department used the Discovery Interview Sheet All sheets gathered in a binder for reference

14 Discovery Interview Sheet (PMG)

15 Impact Analysis The slowest phase (3 months) Action Plan Education Plan ICD-10 Budget

16 Impact Analysis by Department Staff Providers (Doctors, NPs, PAs) Volunteer Primary Care Providers Volunteer Specialists Coordinators (Referral Specialists) Lab Staff Pharmacy Behavioral Health Providers Dental Team (DDS) Health Education Department Nursing (RN, LVN, MAs) IT Billing Finance

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18 Education Plan: Staff Providers Weekly One Minute Provider Training (1 MPT) slides ed to providers Monthly ICD-10 quiz during providers meeting PMG App for smart phones

19 1-MPT slides sent to providers weekly

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21 Slides available on app

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23 Education Plan: Staff Providers Two face-to-face training sessions to review material Survey to evaluate providers level of readiness and engagement Run a report on top 100 ICD-9 codes used at VFC by specialty Building favorites in NextGen EHR Using ICD-10 codes before 10/1/2015 Cheat sheets (Quest Diagnostics)

24 Volunteer Physicians: Here lies our challenge!! A wonderful asset to have for our patients; high quality and mission driven Retired and practicing physicians Documenting in NextGen has proved challenging specialists notes are scanned in EMR Our coordinators enter the ICD-9 code on a paper fee ticket Do you see the challenge with ICD-10?

25 Volunteer Physicians: No easy solution Coordinators need to know enough about the nuances of ICD-10 to recognize when more specificity is needed (almost always most likely) and query the specialists concurrently (verbal query) Purchase ICD-10 coding book Specialty-specific cheat sheets will likely be needed Specialty-focused education will likely be needed Survey Monkey to assess readiness 50% of the new ICD-10 codes are related to musculoskeletal diagnoses

26 Behavioral Health Services They will be going live on EMR on 6/22/2015 Fewer experiences with ICD-9 Reports of Top BH ICD-9 codes used No mapping 1 MPT slides related to BH diagnoses will be ed weekly to them starting in July A face-to-face training will be planned for July and September

27 VFC Dental Services Currently document in EDR (QSI Dental) Dentists use fewer ICD-9 codes than providers Dental Roundtable helpful in expanding this list Might consider mapping for this department Education plan: starting 8/1/2015

28 VFC Nursing Staff ICD-9 codes are used for standing orders ICD 9 for nurse visits: PPD, CXR orders for positive PPD, wound care, etc. List of currently used ICD-9 codes is available Mapping will likely work here as well Education plan: training 8/1/2015; cheat sheets (Quest Diagnostics)

29 Technology Vendor Assessment

30 Billing/Finance Department Impact analysis using above mentioned forms with vendors and payers: Office Ally, Medi-Cal, Medicare, MD On-Line, MHLA Are we able to quickly track rejected claims or see a spike in denials and give prompt feedback to providers? Workflow changes needed A part time coder might be able to perform some chart audits Revision of contracts with payers; do we have enough bandwidth for this? Review and update reporting processes

31 The next few weeks Finalize our Education Plan Finalize our budget: budget a 10% decrease in providers productivity for at least 3 months after 10/1/2015 Testing: External: unable to participate in CMS end to end testing Internal: testing NextGen upgrade to UD2, KBM8.3.10

32 Still so much to do I hope we did it right! Questions?